| NPI | 1740851096 |
|---|---|
| Doing Business As | JACKSON UROLOGY EAST TROY |
| Entity Type | Organization |
| Authorized Contact | TARA HERRING Revenue Cycle Director 334-240-2337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2021-07-08 |